Exercise for Lower Back Pain With Expert Sydney Exercise Physiologists

Exercise is among the most effective treatments for low back pain. A large and growing body of research shows that exercise for back pain, when done correctly, can not only reduce pain but also enhance mobility and prevent future injury. But It’s important that you find the right exercise program, one that suits your particular needs and ability, and is safe and effective. That’s where accredited exercise physiologists can help. University-qualified experts, accredited exercise physiologists specialise in prescribing exercises for back pain and other musculoskeletal conditions.

When prescribing exercise for back pain, it’s essential to clarify which type of movements help the pain and which ones aggravate it, especially in the early stages. A well-designed exercise program, tailored to an individual’s specific condition and overseen by professionals, maximises the effectiveness of the exercise plus keeps the person safe as they progress through the program. Central Performance in Surry Hills, Sydney, have a team of accredited exercise physiologists who specialise in working with clients to guide them through the Central Performance Back Pain Program. This unique personalised exercise program increases back strength and flexibility, relieves pain, and improves the client’s ability to do exercise and daily activities.

Understanding Low Back Pain

Understanding low back pain, including its causes, diagnosis, and the fundamentals of effective treatment, is important for successfully managing it. For this reason we always focus on education early in your back pain program, so that you really understand what’s going on, the main goals of that phase of your treatment, and the benefits you get from doing each exercise. Understanding back pain better also helps clarify why some activities and exercise are helpful, while others can be aggravating for your back.

The Science Of Back Pain

Back pain is a complex condition and there is a lot of variation between cases. Each person’s case of back pain will be different to the next one, making diagnosis and management challenging. However, it’s important to remember that the vast majority of cases of LBP do not involve serious damage or pathology, even though the pain may be relatively severe at times. Additionally, most cases don’t require imaging such as X-rays, MRI, or CT scans, as they generally aren’t necessary for diagnosis and don’t alter how we manage most cases. There are times when imaging is useful however, your health provider should discuss this with you if they feel it is required.

When we examine the research on treating the majority of low back pain cases, it’s clear that exercise consistently emerges as one of the most effective options. In some cases, combining it with initial manual therapy (hands-on treatment) and simple medications like Panadol or Neurofen, particularly in the early acutely painful stage, yields the best results. However, as the pain diminishes, researchers have shown that properly targeted exercise achieves the most effective resolution of the symptoms. Importantly, once the pain has resolved, exercise and building strength is the most effective way to minimise the risk of future problems.

What Causes Lower Back Pain?

We diagnose (or classify) low back pain into three diagnostic groups. This helps us to decide the best treatment plan for each case, although there is still a lot of variation in how we manage each client. It also helps us screen out if further investigation using imaging (MRI, CT or x-ray) or referral on to a specialist is required, although it should be highlighted that referral on for further investigation is rarely needed. The vast majority of back pain responds very well to exercise treatment without the need for imaging or specialist referral. The three type of back pain are as follows.

1. Non-Specific Low Back Pain

 This is by far the most common type of back pain, making up about 90% of cases. You may feel the pain around the lower back, which may refer down into the thighs, and it can range from mild to severe. There is no numbness, pins-and-needles or muscle weakness. Several spinal structures including joints, discs, muscles, and ligaments can cause it. It may have started after a particular incident such as a heavy lift, or it may have just started without any particular reason.

2. Radicular Pain – Commonly Called Sciatica, Nerve Root Pain or a Pinched Nerve

This type accounts for 5-10% of low back pain cases. It occurs when a compressed nerve exits the spine, causing pain that runs from the back down into the leg. Neurological symptoms, including numbness, tingling, weakness, and pins-and-needles sensations, may accompany the pain. Clinical testing of nerve function may show reduced reflexes, power or sensation. If nerve compression is present then it is important to begin treatment to relieve the compression as possible. As with non-specific low back pain, radicular back pain can also be either from a specific incident or for no memorable cause.

3. Serious Pathology

This is very rare, making up less than 1% of lower back pain cases. It includes spinal fractures (broken bones), tumors, and some types of infection and inflammatory diseases. Specific screening questions and tests can effectively identify possible serious pathology, and then imaging (MRI, CT, x-ray) clarifies the diagnosis.

For more information you can read our full blog post on Diagnosing the 3 Types of Lower Back Pain

Exercise Is Effective In The Treatment Of Back Pain

When managing back pain, incorporating exercise is crucial. Extensive research shows that it reduces pain, increases range of movement, helps the pain go away more quickly, and reduces the risk of it coming back in the future. Many people are fearful of moving and exercising when they are in pain, and this is completely understandable if they are not sure what is causing the pain or if they are doing more damage by exercising through pain. However, when done correctly under the right guidance, exercise usually provides the most benefit for managing back pain. Having the right diagnosis, screening out any need for further referral, and then being educated on what the problem is and how to fix it, allows you to begin moving and exercising again while being confident that you are not causing any damage to your back.

Is It Safe To Exercise If You Have Back Pain?

Yes, exercise is not only safe but very beneficial if you have back pain. Only in very rare circumstances, for example if you have had significant trauma and have something like a vertebral fracture that has not been diagnosed, is exercise harmful. The above three-category diagnostic system is designed to screen for this. After ruling out “serious pathology” as an important first step, the focus should be on exercise for managing back pain.

Although research strongly supports exercise for back pain, it’s important that you perform the right exercise at the right time and in the right way. Trying to exercise too intensely can flare up your pain, but going too conservatively can also make the pain stay around for longer because you’re not moving enough. In some cases extension-based exercise (i.e. movement into back-bending type positions) can be very helpful, while in other cases this can really aggravate the pain. The same goes with flexion-based exercises, i.e. forward-bending type positions. Staying as active as possible as you recover is best, however knowing what discomfort level is ok to work through versus when you need to take a break can be confusing. This is why obtaining a professional diagnosis and a targeted exercise treatment plan is important, delivering far more consistent benefits and results.

What Are The Benefits Of Exercise For Back Pain?

Back pain exercise programs bring many benefits including;

• effectively relieving pain as quickly and safely as possible
• restoring movement and function to help you get back to doing the things you need and want to do
• reducing the risk of future back pain episodes. Research shows that increasing your strength and staying active significantly reduces the likelihood of your pain returning
• prevents or minimises deconditioning while you are recovering, i.e. maintains as much strength, movement and fitness as possible while you get over your back pain before returning to your normal activity and exercise

Recommended Exercise For Back Pain

The research shows that when it comes to back pain exercise there is no single type of exercise that is always more beneficial for every person than other types of exercise. This makes sense because, as discussed above, back pain is complex and there are many factors that can contribute to it, so it is logical that each person’s case will respond differently to different types of exercise. This again highlights the principle that exercise personalisation is the key. Getting on the exercise program that works best for you, and progressing it correctly as you improve, is vital.

In general back pain research supports using a tailored exercise program including strength, flexibility, core stability and cardio components. The research also concludes that in many cases exercising within an acceptable level of discomfort is ok, but the exact level of “acceptable discomfort” will vary significantly between people. Avoiding pain completely and being overly conservative is often unnecessary and can slow down your recovery (this is sometimes termed “fear avoidance” behaviour). Pushing through excessive pain can also prolong your recovery, even though it doesn’t necessarily indicate further damage to your back. Once again, proper assessment and personalisation of your program is crucial.

Which Type Of Exercise Is Best For Low Back Pain?

Low back pain generally responds well to a mix of strengthening and mobility exercises. Adding in some progressive cardio is also good, for example starting with walking then progressing to running, swimming or machine-based cardio. Some people find that “core exercises”, targeting the muscles around the spine, pelvis and abdominals, are good, especially in the early stages.

Exercise preferences and past experience are also important. For example someone who loves the gym and has lots of strength training experience will likely respond well to a targeted gym-based strength program, whereas someone who is used to doing Pilates several times a week and really enjoys it may respond better to a Pilates-based program. Similarly a regular swimmer will usually respond well to an early re-introduction of swimming into their program, but someone who never regularly swims but loves walking may be better off using timed walks for cardio and general fitness.

Strengthening Exercises For Your Lower Back

Strength exercises should form the main part of exercise programs for lower back pain. The research shows that there are not one or two strength exercises that are better than all the others for back pain, but rather that you find the right mix that works for you. You can check out our blog post on strength training for low back pain for more info. Common examples of strength exercise for back pain include;

• squats and squat variation, for example goblet squat, back squat, banded squats…
• lunges and split squats, for example lunges progressing from body-weight up to loaded, Bulgarian split squats…
• Pallof press using a cable or resistance band
• deadlifts, with variations including trap bar deadlifts, progressing to RDLs… Many people hesitate to begin or resume deadlift exercises after experiencing back pain, but when done correctly and using the appropriate variation and weight, they can be among the most effective ways to strengthen your lower back muscles.

Stretching For Back Pain Relief

Stretching can be helpful for short-term relief from pain, especially in the early stages of an episode of back pain. As well as reducing pain, stretching can reduce muscle tension and therefore help restore range of movement. As with strength exercises, there are a wide variety of stretches that can help with back pain, so it’s a question of finding the ones that work best for you. For some examples of common stretches that can be helpful for back pain you can read our blog post on stretching for back pain.

Core Stability (Core Strength) Exercise For Back Pain

In general, “core muscles” refer to the muscles around the lower spine, abdominals, glutes, and pelvic muscles, including the pelvic floor. However, there is still lots of debate about exactly what they are, what they do, and how best to strengthen them. Importantly, research shows that “core stability” exercises are generally not significantly more effective than other types of strength exercise for back pain. This once again this follows the principle of “exercise is effective for back pain relief, but there is no particular type of exercise that has been proven to be better than other types of exercise, so you need to find the type that works best for you“.

Just to complicate things more, you can argue that almost any type of strength exercise is a “core stability” exercise. This is because whenever we lift, carry, push or pull a weight, our core muscles must contract to support our spine and pelvis while taking the load. So, common exercises like squats, lunges, sled pushes, deadlifts and shoulder presses will all recruit the core muscles, even though we may not think of them as “core exercises”. They are sometimes called “functional core exercises” because they are functional movements that activate and strengthen the core muscles even though they don’t specifically target them.

When people talk about core stability exercises they are generally talking about activating the abdominals and lower back muscles. Common examples of core strength exercises include;

• plank variations including front and side planks, shoulder taps and side-plank rows
• bird dogs, i.e. quadruped position then extending alternate arms and legs while keeping your trunk and pelvis still
• Pallof press and single-leg Pallof press
• sit-ups, abdominal crunches and V-sits

Is Pilates Good For Back Pain?

Pilates is probably the most widely recognised type of exercise that focuses on the core muscles. However, it is really a whole-body workout that does much more than just work on your core muscles. Specifically, clinical Pilates is Pilates that is taught by a physio and is used to help clients recover from injury, as opposed to regular Pilates which is more aimed at general health and fitness. Read more about the difference between clinical Pilates and regular Pilates.

Research shows that Pilates does help people recover from back pain, and it’s a great (and very popular) option if you enjoy this type of exercise. However, once again, it has not been shown to be superior to other types of exercise for back pain, so it’s back to the same principle: exercise is great for back pain, you just need to find the type that works well for you and that you enjoy. Finding the type you enjoy is important because for exercise to be effective it needs to be consistent over a period of time, and this is much easier to achieve if you enjoy what you are doing.

Exercises To Avoid If You Have Back Pain

The same principles of personalisation and variability between people that apply for selecting beneficial exercise also apply when thinking about exercises to avoid during a back pain episode. For example a backbend (cobra) exercise may really flare one person’s back pain up and therefore should be avoided, however, another person may find that this really relieves their pain and is therefore a great exercise to do. So, an exercise that one person should avoid can actually be really beneficial for another, once again highlighting that being prescribed the right program for you is crucial.

Although there is a lot of variability between people so we can’t really say a specific exercise is “bad for all low back pain people”, there are principles and guidelines to use when deciding if an exercise should be avoided or not. As discussed above, getting your back properly assessed and building an exercise program that is safe an effective for your particular situation is important,

Some Simple Principles For Exercise To Avoid With Back Pain

• be guided by your pain. If an exercise feels like it relieves your pain, or at least doesn’t make it worse, then it’s probably ok (and often beneficial) to keep doing it
• With chronic, persisting or recurrent pain it is often ok to exercise through some discomfort, whereas with recent-onset acute pain we generally don’t want to do exercise that increases the pain significantly
• If you go to the gym then you may want to reduce your weights to a level that doesn’t overly strain your back, make it feel tighter or increase your pain. However, if possible it’s best to stay active within comfort, so try to “reduce” things rather than “stop” things completely, although there may be some exercises which you need to take a break from while your pain settles (see the next point)
• Some common gym exercises like deadlifts, squats, back extensions, and ab curls/crunches often aggravate back pain in the early stages, so you may need to stop these for a while. However, when you feel comfortable, gradually restart them (if they are usually in your program and you are confident with your technique), using lower weight/reps and then building up as you can.

Should You Rest Or Keep Moving If You Have Back Pain?

When someone experiences back pain, the instinct might be to rest and limit movement. However, current health advice strongly indicates that staying active is a better choice. Research indicates that maintaining appropriate physical activity can help manage back pain, speed up the healing process and improve overall outcomes. The difficulty is usually in determining what the “appropriate level of physical activity” is.

• Movement: For most cases of back pain, especially if chronic or recurrent, staying active is key. Gentle activities like walking, swimming, or just being active throughout the day, can maintain flexibility and function. Essentially, try to keep doing as many of the normal things that you do within your comfort limits.
• Rest: In the immediate time of acute back pain, brief rest periods may be beneficial. These should be short, typically no longer than a day or two. Extended rest often leads to muscle weakening and decreased mobility, and can make it take longer to recover form the pain.

Professional Support And Guidance

Finding the right balance of rest versus exercise, and which exercises to do and how to progress them, is where the Back Pain Program can really help. It not only helps you recover from your current pain, but it focuses on strengthening your back to minimise your risk of future problems. And you can be confident that your program is designed and supervised by one of our accredited exercise physiologists who is experienced in managing many back pain clients.

What’s The Difference Between An Exercise Physiologist And A Personal Trainer?

Exercise Physiologists are allied health professionals with university qualifications. They have a thorough knowledge of the human body and are trained to deal with chronic health conditions, such as low back pain, by designing specialised exercise interventions. Personal Trainers, on the other hand, are fitness professionals who focus on general fitness and might not have the expertise required to effectively manage clinical conditions such as low back pain. While personal trainers can help with general health and fitness goals, exercise physiologists are suited for individuals who need a clinical approach to their exercise, for example recovering from back pain or spinal surgery. To learn more about the difference between exercise physiologists and personal trainers you can read our blog on the subject.

Central Performance Exercise Physiologists

Central Performance is conveniently located in Surry Hills, near Sydney’s CBD and just a few minutes from Central Station. Our accredited exercise physiologists play a crucial role in bridging the gap between rehabilitation and enhanced fitness and sports performance. Clients receive personalised attention, with programs designed to restore optimal movement patterns, recover from injuries, and improve overall physical health. Our fully-equipped onsite gym has everything you need to build strength, flexibility and endurance, plus our friendly team and welcoming atmosphere make attending your sessions a pleasure. We work with clients of all fitness levels, abilities and ages. Plus our back pain clients include a wide range of people, from those experiencing their first episode of pain through to chronic or recurrent cases.

The clinic operates with extended hours, from early morning to evening, providing flexibility for clients to schedule appointments that align with their busy lifestyles. Our team uses a comprehensive approach to healthcare, integrating the latest in exercise science with practical, client-centred treatments. Click below to make an enquiry or to book an exercise physiology appointment.

Frequently Asked Questions

Which exercises are most effective for relieving back pain?

There are no exercises that are ideal for every case of lower back pain. What is perfect for one person may be aggravating for another. In general having a mix of strength, flexibility, core stability and cardio exercise is recommended. However, the most important thing is to get on a personalised exercise program that is tailored for your particular needs and based on a professional assessment.

Are there specific exercise programs that target back pain reduction?

Yes, the Central Performance Back Pain Program specifically targets relief from back pain. This 5-step program guides you through an initial assessment, introductory exercises as you begin the rehab phase, and progresses through to effective strength and conditioning to get you strong and confident about returning to activity, sport and exercise.

Should You rest or keep moving if you have back pain?

While a short period of rest may be required in acute-onset cases of back pain, the main message is to keep moving within comfort. Extensive research shows that keeping as active as possible while you recover makes your pain go away faster and your overall recovery is better. This is especially important for recurrent or chronic cases of back pain.

What are safe exercises to perform if you have acute back pain?

Safe and helpful exercises for acute back pain will vary from person to person. There is no single exercise that is “safe” for everyone, because a single exercise may reduce pain in one person but increase pain in another. The important message is to try to keep moving and exercising as much as you feel comfortable within your pain limits. Generally low intensity, gentler exercise is helpful early on, for example walking and swimming. Pilates can also be very beneficial if you don’t feel confident getting back into more intense exercise to begin with.

Can strengthening exercises improve back pain, and if so, which ones?

Strengthening exercises are one of the best ways to improve back pain and avoid it coming back in the future. By strengthening the muscles around the spine, pelvis and hips, you increase your body’s ability to lift, carry, push and pull weights, either during normal daily activity or during exercise like the gym. There is no particular strength exercise that is right for everyone, so having your back properly assessed and then using an exercise program that is tailored for your particular needs is important.